| Formulary Chapter 8: Malignant disease and immunosuppression - Full Chapter
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| Notes: |
Hameatology/Oncology related Prescribing Guidance
Please see our Prescribing Guidelines page for all prescribing guidance relating to this chapter.
Haematology/Oncology related Shared Care Agreements
Please see our Shared Care Agreements page for all shared care agreements (SCAs) relating to this chapter.
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| Details... |
| 08.02 |
Drugs affecting the immune response |
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Blinatumomab
(Injection)
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Formulary
 
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 NICE TA450 : Blinatumomab for previously treated Philadelphia-chromosome-negative acute lymphoblastic leukaemia
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| 08.02.01 |
Antiproliferative immunosuppressants |
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Azathioprine
(Tablets)
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Formulary
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- 25mg and 50mg tablets
- Chemotherapy/post transplant
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Mycophenolate Mofetil
(Oral )
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Formulary
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- 250mg capsules
- 500mg tablets
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Mycophenolate mofetil, mycophenolic acid: new pregnancy-prevention advice for women and men
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| 08.02.02 |
Corticosteroids and other immunosuppressants |
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Ciclosporin
(Capsules)
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Formulary
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- 25mg, 50mg and 100mg capsules
- Indicated for bone marrow stem cell transplant.
- The brand to be dispensed should be specified by the prescriber due to differences in bioavailability.
- Preparations are not interchangeable.
- RUH and SFT - Neoral
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Tacrolimus
(Capsules)
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Formulary
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- 500microgram, 1mg and 5mg capsules
- Indicated for bone marrow stem cell transplant.
- The brand to be dispensed should be specified by the prescriber due to differences in bioavailability.
- Preparations are not interchangeable.
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Oral tacrolimus products: reminder to prescribe and dispense by brand name only
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Ciclosporin
(Capimune ®Deximune®Neoral®)
(Capsules)
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Formulary
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- 25mg, 50mg and 100mg capsules
- For SOLID organ transplant patients continue on brand specifed by the specialist.
- Preparations are not interchangeable.
- NHSE commissioner when ciclosporin used for solid organ transplants. Available from Specialist Centres ONLY.
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Ciclosporin
(Sandimmun®)
(Injection)
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Formulary
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Tacrolimus
(AdoPORT ®Prograf®Advagraf®)
(Capsules)
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Formulary
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- AdoPORT 500microgram, 750microgram, 1mg, 2mg and 5mg capsules
- Prograf 500micrograms, 1mg, and 5mg capsules
- Advagraf 500microgram, 1mg, 3mg, 5mg modified release capsules
- For SOLID organ transplant patients continue on brand specifed by the specialist prescriber.
- Preparations are not interchangeable.
- NHSE commissioner when tacrolimus used for solid organ transplants. Available from Specialist Centres ONLY.
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| 08.02.03 |
Anti-lymphocyte monoclonal antibodies |
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Alemtuzumab
(Injection)
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Formulary
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Feb 2020 MHRA DSU - Lemtrada▼ (alemtuzumab): updated restrictions and strengthened monitoring requirements following review of serious cardiovascular and immune-mediated reactions
NICE TA312: Alemtuzumab for relapsing‑remitting multiple sclerosis
 MHRA Drug Safety Update (May 2019):Lemtrada (alemtuzumab) and serious cardiovascular and immune-mediated adverse reactions
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Obinutuzumab
(Injection)
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Formulary
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NICE TA343: Obinutuzumab with chlorambucil for CLL
NICE TA513:Obinutuzumab for untreated advanced follicular lymphoma
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Ocrelizumab
(injection)
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Formulary
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NICE TA533: Ocrelizumab for treating relapsing–remitting multiple sclerosis
NICE TA585: Ocrelizumab for treating primary progressive multiple sclerosis
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Rituximab
(Truxima)
(injection)
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Formulary
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- 100mg/10ml and 500mg/50ml infusion
- Prescribe by Brand Biosimilar First Line
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NICE TA 137 Rituximab for the treatment of relapsed or refractory stage III or IV follicular non-Hodgkin’s lymphoma
NICE TA 243 Rituximab for the first-line treatment of stage III-IV follicular lymphoma
NICE TA174 Rituximab for the first-line treatment of chronic lymphocytic leukaemia
NICE TA193 Rituximab for the treatment of relapsed or refractory chronic lymphocytic leukaemia (TA193)
NICE TA226 Rituximab for the first-line maintenance treatment of follicular non-Hodgkin’s lymphoma
NICE TA649 Polatuzumab vedotin with rituximab and bendamustine for treating relapsed or refractory diffuse large B-cell lymphoma
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Rituximab
(MabThera®)
(Subcutaneous injection)
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Formulary
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- 1400mg/11.7ml injection
- For single agent maintenance for follicular lymphoma according to NHSE Circular SSC 1434 July 2014
- Prescribe by Brand
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| 08.02.04 |
Other immunomodulating drugs |
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Dimethyl fumarate
(Oral)
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Formulary
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- 120mg and 240mg capsules
- NB Tecfidera brand only licensed for Multiple Sclerosis
- Check full blood counts before prescribing dimethyl fumarate and then every 6 to 12 months. Stop treatment immediately if progressive multifocal leukoencephalopathy is suspected.
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NICE TA320: Dimethyl fumarate for multiple sclerosis
MHRA DSU Jan 2021 Dimethyl fumarate (Tecfidera): updated advice on the risk of progressive multifocal leukoencephalopathy (PML) associated with mild lymphopenia
MHRA DSU Mar 2015 Dimethyl fumarate (Tecfidera): fatal PML in an MS patient with severe, prolonged lymphopenia
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Dinutuximab
(Injection)
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Formulary
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- 20mg/4.5ml infusion
- Only for use in line with NHSE commissioning (see link below)
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NICE TA538: Dinutuximab beta for treating neuroblastoma
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Fingolimod
(Capsules)
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Formulary
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NICE TA254: Fingolimod for highly active relapsing remitting multiple sclerosis
Clinical Commissioning Policy: Disease Modifying Therapies for Patients with Multiple Sclerosis (MS)
EMC Risk Minimisation materials: Gilenya (fingolimod)
MHRA DSU Jan 2021 Fingolimod (Gilenya): updated advice about the risks of serious liver injury and herpes meningoencephalitis
MHRA DSU Sep 2019 Fingolimod (Gilenya): increased risk of congenital malformations; new contraindication during pregnancy and in women of childbearing potential not using effective contraception
MHRA DSU Dec 2017 Fingolimod (Gilenya): new contraindications in relation to cardiac risk
MHRA DSU Dec 2017 Fingolimod (Gilenya): updated advice about risk of cancers and serious infections
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Lenalidomide
(Capsules)
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Formulary
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Immunomodulatory drugs and pregnancy prevention: temporary advice for management during coronavirus (COVID-19)
Lenalidomide (Revlimid): risk of serious hepatic adverse drug reactions – routine monitoring of liver function now recommended
Lenalidomide: risk of thrombosis and thromboembolism
NICE TA 322 Lenalidomide for treating myelodysplastic syndromes associated with an isolated deletion 5q cytogenetic abnormality
NICE TA 586 Lenalidomide plus dexamethasone for multiple myeloma after 1 treatment with bortezomib
NICE TA171: Lenalidomide for the treatment of multiple myeloma in people who have received at least 2 prior therapies
NICE TA587 Lenalidomide plus dexamethasone for previously untreated multiple myeloma
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Niraparib
(Capsules)
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Formulary
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Nivolumab
(Injection)
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Formulary
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Oct 2019 - reports of cytomegalovirus (CMV) gastrointestinal infection or reactivation
NICE TA384: Nivolumab for treating advanced (unresectable or metastatic) melanoma
NICE TA400: Nivolumab in combination with ipilimumab for treating advanced melanoma
NICE TA417: Nivolumab for previously treated advanced renal cell carcinoma
NICE TA462 : Nivolumab for treating relapsed or refractory classical Hodgkin lymphoma
NICE TA655: Nivolumab for advanced squamous non-small-cell lung cancer after chemotherapy
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Olaparib
(Oral)
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Formulary
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- 50mg capsules
- NB other strengths exist these are not formulary
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NICE TA381: Olaparib for maintenance treatment of relapsed, platinum-sensitive, BRCA mutation-positive ovarian, fallopian tube and peritoneal cancer after response to second-line or subsequent platinum-based chemotherapy
NICE TA598: Olaparib for maintenance treatment of BRCA mutation-positive advanced ovarian, fallopian tube or peritoneal cancer after response to first-line platinum-based chemotherapy
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Osimertinib
(Capsules)
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Formulary
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NICE TA 653: Osimertinib for treating EGFR T790M mutation-positive advanced non-small-cell lung cancer
NICE TA654: Osimertinib for untreated EGFR mutation-positive non-small-cell lung cancer
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Panobinostat
(Capsules)
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Formulary
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- 10mg, 15mg and 20mg capsules
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NICE TA380: Panobinostat for treating multiple myeloma after at least 2 previous treatments
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Pegaspargase
(Injection)
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Formulary
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NICE TA408: Pegaspargase for treating acute lymphoblastic leukaemia
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Pomalidomide
(Capsules)
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Formulary
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Immunomodulatory drugs and pregnancy prevention: temporary advice for management during coronavirus (COVID-19)
NICE TA388: Pomalidomide for myeloma
NICE TA427: Pomalidomide for multiple myeloma previously treated with lenalidomide and bortezomib
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Siponimod
(Tablets)
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Formulary
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- 250 microgram and 2mg film coated tablets
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NICE TA656: Siponimod for treating secondary progressive multiple sclerosis
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Teriflunomide
(Tablets)
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Formulary
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Clinical Commissioning Policy: Disease Modifying Therapies for Patients with Multiple Sclerosis (MS)
NICE TA303: Teriflunomide for relapsing remitting MS
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Thalidomide
(Capsules)
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Formulary
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Immunomodulatory drugs and pregnancy prevention: temporary advice for management during coronavirus (COVID-19)
NICE TA228: Bortezomib and thalidomide for the first‑line treatment of multiple myeloma
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| 08.02.04 |
Interferon Alfa |
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Peginterferon Alfa
(Injection)
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Formulary
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- 90microgram/0.5ml, 135microgram/0.5ml and 180microgram/0.5ml pre-filled syringes
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NICE TA106: Hepatitis C - peginterferon alfa & ribavirin
NICE TA200: Hepatitis C - peginterferon alfa & ribavirin
NICE TA300: Hepatitis C - peginterferon alfa
NICE TA75: Hepatitis C - pegylated interferons, ribavirin & alfa interferon
NICE TA96: Hepatitis B - peginterferon alfa
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Peginterferon Alfa
(Injection )
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Formulary
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- 90microgram/0.5ml, 135microgram/0.5ml and 180microgram/0.5ml pre-filled syringes
- For the treament of leukaemia and lymphoma in accordance with cancer network guidelines
- For the treatment of Myeloproliferative Neoplasms e.g Essential Thrombocythaemia, Polycythaemia after hydroxycarbamide or anagralide.
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| 08.02.04 |
Interferon beta |
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Interferon Beta
(Injection)
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Formulary
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- 30microgram/0.5ml pre-filled (6 million units) syringes
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Clinical Commissioning Policy: Disease Modifying Therapies for Patients with Multiple Sclerosis (MS)
NICE TA527 Beta interferons and glatiramer acetate for treating multiple sclerosis
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Interferon Beta
(Extavia®)
(Injection)
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Formulary
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- Extavia® 250 microgram/ml powder and solvent for solution for injection
- After reconstitution, each ml contains 250 microgram (8.0 million IU) of recombinant interferon beta-1b
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Clinical Commissioning Policy: Disease Modifying Therapies for Patients with Multiple Sclerosis (MS)
NICE TA527 Beta interferons and glatiramer acetate for treating multiple sclerosis
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Interferon Beta
(Rebif®)
(Injection)
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Formulary
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- 22micrgoram/0.5ml and 8.8microgram/0.2ml cartridges and pre-filled pens/syringes
- 44microgram/0.5ml cartridges and pre-filled pens/syringes
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Clinical Commissioning Policy: Disease Modifying Therapies for Patients with Multiple Sclerosis (MS)
NICE TA527: Beta interferons and glatiramer acetate for treating multiple sclerosis
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Peginterferon Beta-1a
(Injection )
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Formulary
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- 63microgram/0.5ml, 94microgram/0.5ml and 125microgram/0.5ml pre-filled pens
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Clinical Commissioning Policy: Disease Modifying Therapies for Patients with Multiple Sclerosis (MS)
Link NICE TA527: Beta interferons and glatiramer acetate for treating multiple sclerosis
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| 08.02.04 |
Glatiramer acetate |
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Glatiramer Acetate
(Injection)
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Formulary
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- 20mg/1ml and 40mg/1ml injection
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Clinical Commissioning Policy: Disease Modifying Therapies for Patients with Multiple Sclerosis (MS)
NICE TA527 Beta interferons and glatiramer acetate for treating multiple sclerosis
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| 08.02.04 |
Lenalidomide, pomalidomide, and thalidomide |
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Clarithromycin
(Tablets)
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Formulary
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- RUH only
- Used in combination with lenalidomide and pomalidomide as per DTC899
- 250mg and 500mg tablets
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| 08.02.04 |
Mifamurtide |
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Mifamurtide
(Injection)
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Formulary
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- 4mg infusion
- When used in line with NICE TA235 (as below) and initiated by specialist centres ONLY
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NICE TA235: Osteosarcoma - mifamurtide: guidance
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| 08.02.04 |
Natalizumab |
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Natalizumab
(Injection)
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Formulary
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Clinical Commissioning Policy: Disease Modifying Therapies for Patients with Multiple Sclerosis (MS)
NICE TA127: Multiple sclerosis - natalizumab
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| Non Formulary Items |
Fampridine
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Non Formulary
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Interferon Alfa
(Roferon-A®)
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Non Formulary
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- Pre-filled syringes 3 million / 4.5 million / 6 million International Units interferon alfa-2a* per 0.5 millilitres
- For the treament of leukaemia and lymphoma in accordance with cancer network guidelines
- For the treatment of Myeloproliferative Neoplasms e.g Essential Thrombocythaemia, Polycythaemia after hydroxycarbamide or anagralide.
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Mycophenolate Sodium
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Non Formulary
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Prednisolone
(Post- transplant)
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Non Formulary
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Prednisolone
(Immunosuppressant)
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Non Formulary
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Sirolimus
(Rapamune®)
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Non Formulary
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- Non Formulary Except when used in accordance with NHSE Commissioning Policy for Solid Organ Transplants within specialist centres (not RUH SFT GWH)
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Key |
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Cytotoxic Drug
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Controlled Drug
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High Cost Medicine
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Cancer Drugs Fund
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NHS England |
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Homecare |
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CCG |
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High Cost Drug Approval System |
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Traffic Light Status Information
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